RIMARY CARE PHYSICIANS REport alarming levels of professional and personal distress. Up to 60% of practicing physicians report symptoms of burnout, 1-4 defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment. Physician burnout has been linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and lawsuits and decreased ability to express empathy. 2,[5][6][7] Substance abuse, automobile accidents, stress-related health problems, and marital and family discord are among the personal consequences reported. 4,[8][9][10] Burnout can occur early in the medical educational process. Nearly half of all third-year medical students report burnout 2,11 and there are strong associations between medical student burnout and suicidal ideation. 12 The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the sta-For editorial comment see p 1338. CME available online at www.jamaarchivescme.com and questions on p 1374.Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Design, Setting, and ParticipantsBefore-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Main Outcome MeasuresMindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Results Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [⌬], 8.

We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or “distressed” personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine.

We conducted secondary analyses to determine the relationship between longstanding personality traits and risk for Alzheimer's disease (AD) among 767 participants 72 years of age or older who were followed for more than 6 years. Personality was assessed with the NEO-FFI. We hypothesized that elevated Neuroticism, lower Openness, and lower Conscientiousness would be independently associated with risk of AD. Hypotheses were supported. The finding that AD risk is associated with elevated Neuroticism and lower Conscientiousness can be added to the accumulating literature documenting the pathogenic effects of these two traits. The link between lower Openness and AD risk is consistent with recent findings on cognitive activity and AD risk. Findings have implications for prevention research and for the conceptualization of the etiology of Alzheimer's Disease.

We describe two frameworks in which personality dimensions relevant to health, such as Conscientiousness, can be used to inform interventions designed to promote health aging. First, contemporary data and theory do not suggest that personality is “immutable”, but instead focus on questions of who changes, in what way, why, when, and how. In fact, the notion that personality could be changed was part and parcel of many schools of psychotherapy, which suggested that long term and meaningful change in symptoms could not be achieved without change in relevant aspects of personality. We review intervention research documenting change in personality. Based on an integrative view of personality as a complex system, we describe a “bottom-up” model of change in which interventions to change basic personality processes eventuate in changes at the trait level. A second framework leverages the descriptive and predictive power of personality to tailor individual risk prediction and treatment, as well as refine public health programs, to the relevant dispositional characteristics of the target population. These methods dovetail with and add a systematic and rigorous psychosocial dimension to the personalized medicine and patient-centeredness movements in medicine. In addition to improving health through earlier intervention and increased fit between treatments and persons, cost-effectiveness improvements can be realized by more accurate resource allocation. Numerous examples from the personality, health, and aging literature on Conscientiousness and other traits are provided throughout, and we conclude with a series of recommendations for research in these emerging areas.

The authors assessed the extent to which socioeconomic status (SES) and the personality factors termed the "big 5" (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) represented confounded or independent risks for all-cause mortality over a 10-year follow-up in the Midlife Development in the United States (MIDUS) cohort between 1995 and 2004. Adjusted for demographics, the 25th versus 75th percentile of SES was associated with an odds ratio of 1.43 (95% confidence interval (CI): 1.11, 1.83). Demographic-adjusted odds ratios for the 75th versus 25th percentile of neuroticism were 1.38 (95% CI: 1.10, 1.73) and 0.63 (95% CI: 0.47, 0.84) for conscientiousness, the latter evaluated at high levels of agreeableness. Modest associations were observed between SES and the big 5. Adjusting each for the other revealed that personality explained roughly 20% of the SES gradient in mortality, while SES explained 8% of personality risk. Portions of SES and personality risk were explained by health behaviors, although some residual risk remained unexplained. Personality appears to explain some between-SES strata differences in mortality risk, as well as some individual risk heterogeneity within SES strata. Findings suggest that both sociostructural inequalities and individual disposition hold public health implications. Future research and prevention aimed at ameliorating SES health disparities may benefit from considering the risk clustering of social disadvantage and dispositional factors.

The current study investigated if the Big 5 personality traits predicted interleukin-6 (IL-6) levels in a national sample over the course of 5 years. In addition, interactions among the Big 5 were tested to provide a more accurate understanding of how personality traits may influence an inflammatory biomarker. Data included 1,054 participants in the Midlife Development in the U.S. (MIDUS) biomarkers subproject. The Big 5 personality traits were assessed in 2005-06 as part of the main MIDUS survey. Medication use, comorbid conditions, smoking behavior, alcohol use, body mass index, and serum levels of IL-6 were assessed in 2005-2009 as part of the biomarkers subproject. Linear regression analyses examined personality associations with IL-6. A significant Conscientiousness*Neuroticism interaction revealed that those high in both Conscientiousness and Neuroticism had lower circulating IL-6 levels than people with all other configurations of Conscientiousness and Neuroticism. Adjustment for health behaviors diminished the magnitude of this association but did not eliminate it, suggesting that lower comorbid conditions and obesity may partly explain the lower inflammation of those high in both Conscientiousness and Neuroticism. Our findings suggest, consistent with prior speculation, that average to higher levels of Neuroticism can in some cases be associated with health benefits—in this case when it is accompanied by high Conscientiousness. Using personality to identify those at risk may lead to greater personalization in the prevention and remediation of chronic inflammation.

Background/Aims: Mindfulness-based stress reduction (MBSR) has enhanced cognition, positive emotion, and immunity in younger and middle-aged samples; its benefits are less well known for older persons. Here we report on a randomized controlled trial of MBSR for older adults and its effects on executive function, left frontal asymmetry of the EEG alpha band, and antibody response. Methods: Older adults (n = 201) were randomized to MBSR or waiting list control. The outcome measures were: the Trail Making Test part B/A (Trails B/A) ratio, a measure of executive function; changes in left frontal alpha asymmetry, an indicator of positive emotions or approach motivation; depression, mindfulness, and perceived stress scores, and the immunoglobulin G response to a protein antigen, a measure of adaptive immunity. Results: MBSR participants had a lower Trails B/A ratio immediately after intervention (p < 0.05); reduced shift to rightward frontal alpha activation after intervention (p = 0.03); higher baseline antibody levels after intervention (p < 0.01), but lower antibody responses 24 weeks after antigen challenge (p < 0.04), and improved mindfulness after intervention (p = 0.023) and at 21 weeks of follow-up (p = 0.006). Conclusions: MBSR produced small but significant changes in executive function, mindfulness, and sustained left frontal alpha asymmetry. The antibody findings at follow-up were unexpected. Further study of the effects of MBSR on immune function should assess changes in antibody responses in comparison to T-cell-mediated effector functions, which decline as a function of age.

Objective Personality traits predict both health behaviors and mortality risk across the life course. However, there are few investigations that have examined these effects in a single study. Thus, there are limitations in assessing if health behaviors explain why personality predicts health and longevity. Method Utilizing 14-year mortality data from a national sample of over 6,000 adults from the Midlife in the United States Study, we tested whether alcohol use, smoking behavior, and waist circumference mediated the personality–mortality association. Results After adjusting for demographic variables, higher levels of Conscientiousness predicted a 13% reduction in mortality risk over the follow-up. Structural equation models provided evidence that heavy drinking, smoking, and greater waist circumference significantly mediated the Conscientiousness–mortality association by 42%. Conclusion The current study provided empirical support for the health-behavior model of personality— Conscientiousness influences the behaviors persons engage in and these behaviors affect the likelihood of poor health outcomes. Findings highlight the usefulness of assessing mediation in a structural equation modeling framework when testing proportional hazards. In addition, the current findings add to the growing literature that personality traits can be used to identify those at risk for engaging in behaviors that deteriorate health and shorten the life span.